On a Saturday morning last May, Julia Sachdev, a mother of a 2-year-old and 4-year-old, woke up to an email from her children’s preschool. The school — which her children adored and had been in operation for over 50 years — announced that it would be closing in a month.
In the following days, she and her husband scrambled to find an alternative that was a reasonable driving distance from their home. Most of the places they reached out to had long waiting lists. Some said their waiting lists were full. Some never even called them back.
“It was so stressful,” reflected Ms. Sachdev. “There was this suffocating anxiety that ruled my day. I couldn’t concentrate on other things. It kept me up at night.”
The Sachdevs’ experience is far from unique. For years, American parents — regardless of family roles, paid work status, geography or income — have struggled to find and maintain stable child care. Research shows that roughly half of Americans live in child care deserts, meaning that they have limited or no access to care.
In September, federal relief funding put in place to support more than 220,000 child care programs during the pandemic abruptly expired. This steep drop-off in investment, which has been termed a child-care cliff, is projected to lead to the closing of thousands of preschools and child care centers around the country. Some families are already feeling the impact, and many more may soon find themselves in situations like the Sachdevs’.
The situation has been getting steadily worse for years, and we are now reaching a pivotal moment. As thousands of American families face the daunting prospect of losing their child care, Congress has the opportunity to take immediate action to help alleviate their burden.
We know inadequate child care is an economic issue, costing states, families and businesses billions of dollars every year. We know it’s a gender issue that contributes to a widening pay gap. We know it’s a policy issue, made worse by the absences of a federal pre-K program and a federal paid-leave policy. But here is another critical consideration worth pushing for: Our country’s inadequate child care system is also a health care issue.
For years, parents, particularly mothers, have been shouldering the burden of the child care shortage, assuming additional caretaking responsibilities and shelling out untenable amounts of money to cover the increasing costs of outside care. And we worry that as we begin to see the fallout from this latest wave of disruption, the thin lifelines holding families together and safeguarding the well-being of parents may snap.
It is well documented that stress wreaks havoc on our health. Decades of research have linked chronic stress to increased long-term risks for heart disease, diabetes and autoimmune disorders. Stress is also a key component underlying the onset and maintenance of mental illness.
Research from the pandemic — when families across the world suddenly lost access to child care — continues to suggest links between the additional load of caregiving responsibility and mental health disorders like anxiety and depression, especially for mothers. And inadequate child care intensifies other stressors affecting health as well.
Most obvious, of course, is financial stress. The cost of child care in this country is already astronomical. Currently, the average price of care for two children for a year is higher than the average annual mortgage. For many American parents, the cost of child care is crushing and contributes to financial instability and hardship. Missed or interrupted work because of inadequate child care can also add to financial stress.
The task of finding care can also increase parents’ mental labor load, which can erode psychological health, particularly for mothers. Dwindling child care options mean that parents may have to look harder and travel farther from home to find care, or they may have to rely on an inconsistent patchwork of babysitters and family members to find coverage. And when one child care center closes or one babysitter cancels, the burden of finding an alternative falls to the parents. That process can be arduous. When polled, over half of parents who paid for care said that it would take them at least one month to find a comparable, affordable child care alternative if their current program closed.
Unpredictability itself is a source of stress. Even when parents manage to secure care for their children, it can be unreliable, and they never know when it might go away. Child care precarity — a state of insecure and unreliable child care — has been linked to negative mental health outcomes for mothers for at least six years afterward.
For many families, stressors don’t disappear the moment they secure care. Take the Sachdevs’ case again: In the end, they found another preschool for their children, but it didn’t have the same learning environment as their previous school, and they didn’t know the community there. Without the luxury of being able to carefully consider which school would be the best fit, they made their choice, at least in part, out of necessity.
“We just went with a place that had an available spot,” explained Ms. Sachdev. “And then we had more anxiety for months over whether it was the best place for our kid.”
But while precarity can have negative health effects, the opposite is also true. Research has shown that the perception of stable child care access decreases the risk of maternal depression, underscoring why researchers think lack of child care should be considered a social determinant of health.
Because of unsustainable funding, many child care centers have struggled to maintain full staffs. Shoestring budgets can also mean fewer high-quality educational programs and less one-on-one attention for children. And while most child care centers are safe places, parental stress around safety may have heightened in recent months because of increased media coverage around child care centers that expose children to terrifying risks.
“The most stressful thing now is finding someone who can take my son, meet his needs and be the right price,” said Kristin Spencer, whose school-age son has special needs. “There are a couple of programs that will take him, but we can’t afford them.”
Ms. Spencer explained: “I’ve switched jobs to alleviate our child care issues. We depend a lot on my parents, but they’re aging. It’s cost versus this versus that. It comes to a point where we have to figure a lot out for ourselves. It is really stressful.”
Worse, the parents likely to experience the worst impacts of the child care cliff are people of color and low-wage workers, who are already at the highest risk for stress-related illness.
“These are communities and individuals that don’t have the luxury to say, ‘I guess I’m going to have to stay home’ or ‘I guess I’m going to have to get a nanny,’” said Karen Sheffield-Abdullah, who studies health equity, stress and anxiety at the University of North Carolina, Chapel Hill. “When there is no alternative or Plan B, it can feel hopeless.”
We also expect that the American work force at large will begin to see not only increased absenteeism related to caregiving responsibilities but also mental health issues and burnout related to child care gaps, a consequence well documented for farm families, health care workers and other professions.
Our country still lacks a comprehensive infrastructure to address the growing mental health crisis, and plans to dramatically expand access to mental health care in America will require a significant investment of time and money.
The federal government has an opportunity to significantly alleviate those two crises with one tranche of funding. Urgently, as Congress comes up against a deadline for passing a new spending bill this week, we cannot afford any cuts to funding that will support child care development and early childhood education in the current appropriations bill. Additionally, Congress must act on the president’s request for $16 billion in supplemental emergency child care funding. These funds would sustain child care programs on the verge of closing, so that American families across the country have the stable care options they need.
The funding is a critical bandage on an open wound, but it is not a long-term fix. That $16 billion would be “a bridge that buys time to find a solution,” said Elliot Haspel, a child and family policy expert at Capita, a family policy group. “Child care needs permanent federal investment. We need to shift our mind-set away from child care as an individual responsibility when it actually has a collective benefit. Strong families are the cornerstone of strong communities, strong cities, a strong nation, and if you care about strong families, you need to care about child care and long-term solutions.”
A cornerstone of strong families is mental and physical health. Decreasing the stress load on parents will not only improve their long-term health but will also improve the health of their children. We have an opportunity to recognize that social infrastructure is a critical aspect of mental health. We have an opportunity to alleviate a key source of stress on families and pave the way for more Americans to live healthier lives. This goal should be a priority for us as a country.
It is time to acknowledge that child care is directly tied to health. It is time to appreciate that stable, affordable, accessible, high-quality child care is preventive medicine for decreasing long-term health risks. It is time to value care workers and early childhood educators for the crucial services they provide. It is time to view immediate federal investment in child care as a key part of the solution to address the growing mental health crisis. It is time to fight for permanent federal investment in child care as a critical expenditure, with an exponential effect on the health of Americans for generations to come.
It is time to accept that child care is health care.
Molly Dickens is a physiologist who studies stress and the founder of the Maternal Stress Project. Lucy Hutner is a reproductive psychiatrist and a co-founder of Phoebe, a mental health platform for parents. This article originally appeared in The New York Times.